Head injury/trauma Flashcards
Who are at high risk of head injuries/trauma?
young men elderly - think about anticoagulation previous head injury alcohol and drug abuse low income
When must you give treatment for head injuries?
within an hour - GOLDEN HOUR
What is a mild score on the GCS?
14 or 15
What is a moderate score on the GCS?
9-13
What is a severe score on the GCS?
3-8
What people qualify to have a CT within an hour of a head injury being identified?
GCS <13 on initial assesment CGS <15 after 2 hours of injury suspected open or depressed skull fracture any sign of basal skull fracture focal neurological deficit >1 episode of vomiting suspicion of non accidental injury in children if >65years on anticoagulants dangerous mechanism of injury eg RTA
What are important signs to look out for?
racoon eyes - basilar skull fracture
battle sign - basilar skull fracture
CSF/blood from the ears
What is the worst prognostic factor?
skull fracture and loss of conciousness
What are other prognostic factors to take into consideration?
age >65 - independant risk factor for brain surgery
depth of coma
motor response
pupil reaction
What are the principles of treatment for head injuries?
prevent secondary insults: hypoxia, hypertension, mass lesions and control ICP and CPP
How is ICP controlled?
increased MAP = decreased ICP
removing a large mass from the skull can decrease ICP
keep head at 30 degrees to maximise venous drainage and decrease ICP
can give diuretics
control CO2
make sure they are fully sedated - benzodiazepines
What is the last resort treatment option for raised ICP?
decompressive crainiectomy
What does the body loose the ability to do in brain injuries?
autoregulate BP
What is diffuse axonal injury?
swelling of the axons
occur where the density difference is highest - between gray and white matter
What does diffuse axonal injury cause?
excitotoxicity - where glutamate activates NMDA receptors leading to calcium mediated activation of lipases and proteases -> cell death
